What is health insurance? What are the rights and obligations of health insurance participants according to Vietnamese law?

Health insurance is one of the social security policies organized and managed by the State organization in the field of universal health care, supporting medical examination and treatment through payment support. So what is the health insurance regime? What are the rights and obligations of participants? Let's find out the details with iguide.ai in the article below.

1. What is health insurance?

Health insurance (HI) is a form of compulsory insurance applied to subjects according to the provisions of the Law on Health Insurance for health care, not for profit purposes, organized by the State. This regime is implemented based on the principles of ensuring risk sharing among HI participants.

The health insurance fund is managed centrally, uniformly, publicly, transparently, ensuring a balance between revenue and expenditure and is protected by the State. In addition, the principles on contribution levels, benefits, and medical examination and treatment costs are also strictly regulated.

Thus, it can be understood that health insurance is a type of insurance in the field of public health care. Accordingly, the buyer of health insurance will be paid part or all of the cost of medical examination, treatment, health recovery, etc. if an accident, illness, or disease occurs.

2. What types of health insurance are there?

There are two types of health insurance: compulsory and voluntary.

1) Compulsory health insurance is a form of insurance organized and managed by the State, applied to subjects according to the provisions of the Law on Health Insurance.

2) Voluntary health insurance is a form of insurance provided by private insurance companies, applicable to people who are not subject to compulsory health insurance.

3. What are the benefits of health insurance participants in Vietnam?

Health insurance is a form of health and safety protection for people when they encounter health risks, illnesses, and accidents. People participating in health insurance will enjoy many benefits when going to the doctor as follows:

- Health insurance card: This is a document proving the rights of health insurance participants. Health insurance cards are valid nationwide and are issued free of charge to participants.

- Health insurance for family: Participants can pay health insurance for their family, including spouse, children, parents, grandparents... This is a cost-saving and convenient way to manage.

- Choice of primary medical examination and treatment facility: Participants have the right to choose their primary medical examination and treatment facility according to their needs and conditions. The primary medical examination and treatment facility is the place where participants register for their first medical examination and treatment in the year.

- Medical examination and treatment: Health insurance participants have the right to receive medical examination and treatment according to the services listed by the Ministry of Health. Participants can receive medical examination and treatment at the initial medical examination and treatment facility or be referred to a higher level of care as prescribed by a doctor.

- Payment of medical examination and treatment costs under the health insurance regime: Health insurance participants have the right to receive payment of medical examination and treatment costs from the Health Insurance Fund at different levels of benefits depending on the type of service, type of participant and type of medical examination and treatment. The benefit level can be from 40% to 100% of medical examination and treatment costs.

- To be explained, provided with information, to complain and denounce violations of the law on health insurance: Health insurance participants have the right to be explained and provided with information on regulations, procedures and forms related to the exercise of their rights. Participants also have the right to complain and denounce violations of the law on health insurance by relevant organizations and individuals.

4. What are the obligations of health insurance participants in Vietnam?

Obligations of health insurance participants in Vietnam include:

1) Pay health insurance fully and on time.

2) Use your health insurance card for the right purpose, do not lend it to others.

3) Implement regulations on medical examination and treatment procedures and comply with instructions of health insurance organizations and medical examination and treatment facilities.

4) Payment of medical examination and treatment costs other than those covered by the health insurance fund.